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长时间未经治疗的猪心脏骤停后,用氩气通气可提高存活率和良好神经恢复。

Ventilation With Argon Improves Survival With Good Neurological Recovery After Prolonged Untreated Cardiac Arrest in Pigs.

机构信息

Department of Cardiovascular Medicine Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milan Italy.

Clinic for Ruminants and Swine Large Animal Veterinary Teaching Hospital University of Milan Lodi Italy.

出版信息

J Am Heart Assoc. 2020 Dec 15;9(24):e016494. doi: 10.1161/JAHA.120.016494. Epub 2020 Dec 8.

Abstract

Background Ventilation with the noble gas argon (Ar) has shown neuroprotective and cardioprotective properties in different in vitro and in vivo models. Hence, the neuroprotective effects of Ar were investigated in a severe, preclinically relevant porcine model of cardiac arrest. Methods and Results Cardiac arrest was ischemically induced in 36 pigs and left untreated for 12 minutes before starting cardiopulmonary resuscitation. Animals were randomized to 4-hour post-resuscitation ventilation with: 70% nitrogen-30% oxygen (control); 50% Ar-20% nitrogen-30% oxygen (Ar 50%); and 70% Ar-30% oxygen (Ar 70%). Hemodynamic parameters and myocardial function were monitored and serial blood samples taken. Pigs were observed up to 96 hours for survival and neurological recovery. Heart and brain were harvested for histopathology. Ten animals in each group were successfully resuscitated. Ninety-six-hour survival was 60%, 70%, and 90%, for the control, Ar 50%, and Ar 70% groups, respectively. In the Ar 50% and Ar 70% groups, 60% and 80%, respectively, achieved good neurological recovery, in contrast to only 30% in the control group (<0.0001). Histology showed less neuronal degeneration in the cortex (<0.05) but not in the hippocampus, and less reactive microglia activation in the hippocampus (=0.007), after Ar compared with control treatment. A lower increase in circulating biomarkers of brain injury, together with less kynurenine pathway activation (<0.05), were present in Ar-treated animals compared with controls. Ar 70% pigs also had complete left ventricular function recovery and smaller infarct and cardiac troponin release (<0.01). Conclusions Post-resuscitation ventilation with Ar significantly improves neurologic recovery and ameliorates brain injury after cardiac arrest with long no-flow duration. Benefits are greater after Ar 70% than Ar 50%.

摘要

背景

在不同的体外和体内模型中,惰性气体氩(Ar)的通气显示出神经保护和心脏保护作用。因此,在一种严重的、与临床相关的猪心脏骤停模型中,研究了 Ar 的神经保护作用。

方法和结果

在 36 头猪中诱导心脏骤停,并在开始心肺复苏前不治疗 12 分钟。动物随机分为复苏后 4 小时通气:70%氮气-30%氧气(对照);50%Ar-20%氮气-30%氧气(Ar50%);和 70%Ar-30%氧气(Ar70%)。监测血流动力学参数和心肌功能,并采集连续血样。观察猪至 96 小时以评估存活和神经恢复情况。收获心脏和大脑进行组织病理学检查。每组 10 只动物成功复苏。对照组、Ar50%组和 Ar70%组的 96 小时存活率分别为 60%、70%和 90%。在 Ar50%组和 Ar70%组中,分别有 60%和 80%达到良好的神经恢复,而对照组仅为 30%(<0.0001)。组织学显示皮质中的神经元变性较少(<0.05),但海马体中未见,与对照组相比,Ar 治疗后海马体中的反应性小胶质细胞激活较少(=0.007)。与对照组相比,Ar 治疗组循环脑损伤生物标志物的增加较少,犬尿氨酸途径的激活也较少(<0.05)。Ar70%组的猪还具有完全的左心室功能恢复,梗死面积较小,心脏肌钙蛋白释放较少(<0.01)。

结论

复苏后用 Ar 通气可显著改善长时间无血流期心脏骤停后神经恢复和脑损伤。Ar70%的效果优于 Ar50%。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fab/7955395/ef63499b4644/JAH3-9-e016494-g001.jpg

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